Sodium Polystyrene Sulfonate

KAYEXALATE
 ROUTE/DOSAGE

PO: ADULTS, ELDERLY: 60 mL (15 g) 1–4 times/day.

Rectal: ADULTS, ELDERLY: 30–50 g as needed

q6h.
 INDICATION

Treatment of hyperkalemia
 DRUG CLASS
PHARMACOTHERAPEUTIC: Cation exchange resin.

CLINICAL: Antihyperkalemic.
 MECHANISM OF ACTION
MOA: Releases sodium ions in exchange primarily for
potassium ions across intestinal wall.

Therapeutic Effect: Moves potassium from blood into

intestine to be expelled from the body.
 SIDE EFFECTS
Frequent: High dosage: Anorexia, nausea, vomiting,
constipation.

High dosage in elderly: Fecal impaction (severe stomach

pain with nausea/vomiting).

Occasional: Diarrhea, sodium retention (decreased

urination, peripheral edema, increased weight).

 ADVERSE EFFECTS
Potassium deficiency

may occur

Hypocalcemia, manifested by abdominal/muscle

cramps, occurs occasionally
 Food-Drug Interactions: None known.

Drug-Drug Interactions: Cation-donating antacids,

laxatives (e.g., magnesium hydroxide) may decrease
effect; may cause systemic alkalosis in pts with renal
impairment. Sorbitol (Concomitant use of Sorbitol with
KAYEXALATE has been implicated in cases of colonic
necrosis)
 NURSING RESPONSIBILITIES
Monitor serum potassium, magnesium, calcium, sodium levels frequently.
Assess pt’s clinical condition, EKG
Monitor daily pattern of bowel activity, stool consistency
Once the mixture has been prepared, it should be used straight away. If it
needs to be stored, it should be stored for no longer than 24 hours
When to be administered orally, mix in a small amount of water. It can also be
mixed with food or sweetened liquid
Do NOT mix KEYEXALATE with orange juice or fruit juice which contains
potassium
Instruct patient to not take a double dose to make up for the dose he/she have
missed.
Instruct patient to not heat Kayexalate.
Emphasize the importance of repeated blood work to monitor blood electrolyte
concentrations.
Emphasize to patient that foods with high potassium should be avoided
(melons, bananas, OJ, potatoes)
 EBP
- Initially, gastrointestinal mucosal injury was attributed to the sorbitol, which is commonly
used in solution with the SPS; however, subsequent investigations showed that the resin
itself is capable of causing injury as well
- Severe gastrointestinal adverse events include increased risk of small bowel and colonic
necrosis and perforation. In susceptible individuals, sodium polystyrene sulfonate can also
induce esophageal ischemia and necrosis.
- The most common high-risk groups of Kayexalate- or Kalimate-induced GI injuries are
patients with CKD and ESRD, followed by patients with hypertension and organ
transplantations. However, Kayexalate or Kalimate is given primarily to CKD or ESRD
patients because those are the patients who suffer from hyperkalemia.
- GI adverse effects of Kayexalate or Kalimate are observed in these patients.
- The most common site of GI injuries induced by Kayexalate or Kalimate is the colon.
- Physicians should carefully assess the patient’s intestinal motility and medication history,
multiple medical problems, comorbidity, and surgery before prescribing Kayexalate or
Kalimate for hyperkalemia management, mainly in patients with ESRD. Physicians should
also consider other safer agents when appropriate (such as loop diuretics and other
gastrointestinal potassium binders).
 REFERENCES
Garcia Rodriguez, V., Grami, Z., Laney, J., Cai, Z., & Larson, S. (2020). Esophageal
necrosis associated with SODIUM polystyrene sulfonate (KAYEXALATE) use. Baylor
University Medical Center Proceedings, 33(4), 624–626.
https://doi.org/10.1080/08998280.2020.1801322

Kizior, R. J., & Hodgson, K. J. (2019). Saunders nursing drug Handbook 2019. Elsevier.

Kumar, K., Patel, H., Saad, M., Baiomi, A., & Dev, A. (2021). Kayexalate-Induced esophageal
ulceration in a patient with decompensated Cirrhosis: A review of the literature. Case
Reports in Gastrointestinal Medicine, 2021, 1–4. https://doi.org/10.1155/2021/8831814

Wu, Y. H., Chou, J. W., Lai, H. C., Su, G. S., Cheng, K. S., & Chen, T. W. (2021). Adverse
Gastrointestinal Effects with Kayexalate or Kalimate: A Comprehensive Review. Clinical
and experimental gastroenterology, 14, 1–18. https://doi.org/10.2147/CEG.S278812